Horse Health Declaration Form
Please complete this form within 24hrs of your horses arrival at Yorkshire EC
Horse Name
*
Passport / Microchip Number
*
Horse Sex:
*
Mare
Mare - In Foal
Gelding
Stallion
Stallion - used for breeding
Owner / Rider Phone Number
*
Please enter a valid phone number.
Format: 00000 000000.
Arrival Date
*
-
Day
-
Month
Year
Date
Leaving Date
*
-
Day
-
Month
Year
Date
Reason for staying at Yorkshire EC
*
Yard and Address of where the horse is currently stabled:
*
Biosecurity Checklist
Please tick each box to confirm your horse currently shows NONE of the following clinical signs:
*
recent cough of unknown cause
recent nasal discharge of unknown cause
enlarged lymph nodes
fever (>38.5C)
recent onset of neurological signs of unknown cause
diarrhoea
Please tick each box confirm the above mentioned horse is not under current investigation for:
*
Flu, Strangles, EHV or unknown infection.
has not been in contact with and is not kept on the same premises as a horse known to have or be under investigation for infection.
has been resident in the UK for the last 28 days.
The horse named above must have its temperature taken prior to travel and will not be accepted to YEC should the temperature reading be >38.5C. Please contact us immediately if the temperature is above.
*
I will take the temperature within 24hrs of the horse arriving
I have already taken the temperature of the horse (within the 24hr window)
Temp in Celsius
Should the horse take ill on site, I understand Yorkshire EC cannot cater as a treatment facility and stabling is not available for such, and my horse will need to return home/vets for treatment.
*
I understand
The horse is compliant with Yorkshire EC's Equine Flu Vaccination Policy
*
Has completed the primary course and now has annual (or 6 monthly boosters)
Has completed the first two primary vaccines and is not yet due the 3rd booster
Date of Vaccination
*
-
Day
-
Month
Year
Date
Anything else we should know?
To the best of my knowledge, the information provided above is accurate and complete. I confirm I am over 18 years of age and responsible for the above-named horse. I understand that false or withheld information may result in refusal of services.
Owner Name
*
First Name
Last Name
If not owner, please state your name here
First Name
Last Name
Role: Agent/Rider/Groom
You must have person from the owner to sign
I confirm I am authorised by the owner to complete this form on their behalf.
The owner has provided written or verbal permission for me to sign.
Submit
Should be Empty: